Start with conceiving the baby, I suppose. Either before or after you're expecting, call or email them both and set up meetings with each if you can, see who is a better fit for you. Find about their style of practice, their training, their personalities. Ask anything you want to know about having a homebirth and midwifery care.

Excuse me? I would note that this website was recently listed, together with such other websites as the Feminist Breeder, as one of the top midwifery blogs out there. The blog is hosting an important discussion about issues such as licensing, malpractice insurance and training which should be of importance to any mother contemplating birth with a midwife. The particular article I linked to provides information as to matters such as the differences in training between CNMs and CPMs which can be valuable to a parent deciding what sort of provider is right for her.

Really, is a different viewpoint or perspective so threatening that you have to add "disclaimers" to anyone who has one? Why not let the OP read a wide variety materials and make the choice that is right for her? .

I support homebirth that meets the qualifications set forth in the AAP's 2013 policy on homebirth.

How many times can a website say "extremist fringe" without being extremist itself?

"How do we identify midwives that function on the extremist fringe? This is difficult. The most obvious hint comes in the language they use (not in their credential):

"Trust birth"

"Your body was made to do this"

"You can't grow a baby too big for your body to birth"

"...(insert high risk situation here)...is just a variation of normal"

Gestational Diabetes Screening, Ultrasounds, (other important assessments) are not proven to be useful or safe"

So these things I've seen on MDC before a lot. None of them strike me as unsound if they are just general statements meant to be encouraging. I have not encountered anyone so "fringe" that they would give the same advice to each woman. "Oh, you were in an accident and you and your care providers think that it would not be beneficial to labor for long due to your broken pelvis?... Don't be a wuss! Your body was Made to Do This!"

There can be differences of opinion, but everyone I've read/heard says that midwives of whatever sort should take each case on an individual basis. And I don't think these phrases preclude that. If MDC is too fringe, why be a member?

If I ran into a midwife who thought those phrases were red flags, I'd run from that midwife.

I am all for women making informed choices. Sure, be aware of what kind of midwife you are hiring. That's important. But those catch phrases don't signal anything dangerous to me.

Oh, and congratulations, OP! I recommend you read lots of birth stories to get a good sense of what kind of birth experience you are looking for this time. Then interview providers in your area to see who matches up with that. I'd say that knowing of two midwives already is a good start! Just talk to them! Maybe you'll find a good match, or maybe you'll know to keep looking.

"None of them strike me as unsound if they are just general statements meant to be encouraging."

I don't know how you can take these as "encouraging" statements. In some cases, these are statements of medical advice offered by certain midwives to their patients and all of them can be evidence of a particular philosophy or viewpoint towards birth.

If you are looking for someone to knit in the corner and "hold the space" maybe these words would be reassuring. If you are looking for someone who is going to take a different approach, maybe they're not. The point is is that these kinds of statements (which have been tied to a particular community with a particular philosophy) MEAN something about the speaker. And given how difficult it can be to evaluate a midwife, a patient may need all the help she can get to evaluate her midwife's viewpoint, philosophy, training, experience and skill set.

FYI -- The blogger comes at this issue from the viewpoint of having heard these words: "breech is a variation of normal", only to have her son die during an attempted breech birth at a birth center.

I support homebirth that meets the qualifications set forth in the AAP's 2013 policy on homebirth.

I don't think the tone of that Michigan website is appropriate as what to give out to a person looking for where to start in researching home birth. I can see you feel differently about that, Buzzbuzz. I find some of the information to be incorrect, or at least not helpful to someone who is actually interested in giving birth at home. I mean, look at the titles of the birth stories...not something I would want to see as a pregnant woman. I'm not saying we should avoid stories of bad outcomes, or pretend that all care providers are great. But it seems really biased against home birth.

It makes sense now that you say it is written by a mom whose baby died. That's heartbreaking. I think we all know that... so I actually find reading things like "Safety Trumps your Vision" insulting. Not that I would blame a grieving mom trying to save other people pain, but it just seems to assume that there is this mythical person out there who, if they could see into the future, would still pick a bad outcome for their baby as long as they got their "birth experience." Every woman is making the best decision they can for themselves AND their baby.

You basically just said that you don't see how I could find those statements encouraging...unless I'm some Extremist on the Fringe, who wants someone to act in a "hands-off" manner. I do happen to think that some women birth best when undisturbed. If a woman hires a midwife, at a basic level, she is hiring someone to keep an eye on things and determine if the birth is going normally. I think that how that is determined should be up to the midwife and the woman. Maybe it's visual observation, maybe it's constant monitoring...or somewhere in between. Finding out what you think is safest is part of the research process. So... my issue is that if those statements above mean something, and that something is what you are looking for, that is totally OK and does not mean that you are an irresponsible or uninformed woman.

seeing as the website links to the skeptical OB Im not sure it is one I would recommend for someone new to homebirth, it also has misleading information (ie quoting percentages on obstruction of labour as a way to support the instance of babies being too big to be born while ignoring the fact that many obstructed labours are do to malposition of baby or malnutrition of mother ie third world).

While that list of questions is interesting, it is of limited use, because it doesn't include any information about what the responses might actually mean.

So, you ask your midwife if she attends breech and twin births. And she says yes. What does that mean?

For me, it means that her personal perception of risk is such that she is willing to take on a high risk birth in a place of limited resources and engage in a practice which has no scientific support for its safety (as any study that makes any claims as to safety of homebirth is dependent on the mothers being low-risk). For others it may mean she is a birth warrior willing to take risks with her life due to potential civil and criminal liability (in case of a bad outcome) to give a mother the birth she wants. And finally, for others it may mean nothing -- they may not understand its implications.

That's what the blog is trying to get at in part -- I think we all have to acknowledge that there is a spectrum of practice out there and some practices are more fringe than others.

I support homebirth that meets the qualifications set forth in the AAP's 2013 policy on homebirth.

Outcomes

No maternal deaths occurred. After we excluded four stillborns who died before labour but whose mothers still chose home birth, and three babies with fatal birth defects, five deaths were intrapartum and six occurred during the neonatal period (see box). This was a rate of 2.0 deaths per 1000 intended home births. The intrapartum and neonatal mortality was 1.7 deaths per 1000 low risk intended home births after planned breeches and twins (not considered low risk) were excluded. The results for intrapartum and neonatal mortality are consistent with most North American studies of intended births out of hospital11–24 and low risk hospital births (table 4).14212224–30

Combined intrapartum and neonatal mortality in studies of planned out of hospital births or low risk hospital births in North America (at least 500 births)

Breech and multiple births at home are controversial among home birth practitioners. Among the 80 planned breeches at home there were two deaths and none among the 13 sets of twins. In the 694 births (12.8%) in which the baby was born under water, there was one intrapartum death (birth at 41 weeks, five days) and one fatal birth defect death.

Apgar scores were reported for 94.5% of babies; 1.3% had Apgar scores below 7 at five minutes. Immediate neonatal complications were reported for 226 newborns (4.2% of intended home births). Half the immediate neonatal complications concerned respiratory problems, and 130 babies (2.4%) were placed in the neonatal intensive care unit.

I am set on a HB for my next pregnancy. I know of two HB MW near me and I just don't know where to start with all this!!

Hi, MedicBaby21 and welcome to MDC!

I think starting by reading is a great idea. I support the idea of reading both pro-HB sources as well as skeptical sites. Obviously, some are better than others and there is also the issue of personal preference. My favorite site is Midwifery Today. I also like to search old MDC threads to see which studies and issues I want to delve deeper into. My preference is for articles and websites that reference original sources and then to read those as your primary source of information.

Other things to consider is the climate for HB in your area. Sometimes the choice is made for you (in my area finding a HB MW is nearly impossible right now). In other cases, you will have additional factors to consider, including things like safety of transfer care and certain restrictions on midwifery care and etc.

The point is is that these kinds of statements (which have been tied to a particular community with a particular philosophy) MEAN something about the speaker. And given how difficult it can be to evaluate a midwife, a patient may need all the help she can get to evaluate her midwife's viewpoint, philosophy, training, experience and skill set.

I do think the article you linked has a good perspective other than that list of things "radical MWs" say. I think a lot of those things are perfectly reasonable things to discuss in terms of general birth. I urge the OP to read that article (because it's pretty good, IMO) but to avoid negatively characterising a MW if she uses some of those phrases and concepts.

I, myself, am not a fan of the phrase "variation of normal" but a lot of the other phrases are things that would not bother me to hear.